Prediction of appropriateness of local endoscopic treatment for high-grade dysplasia and early adenocarcinoma by EUS and histopathologic features

doi:10.1016/S0016-5107(04)02017-6

Gastrointestinal Endoscopy

Volume 60, Issue 5, November 2004, Pages 703-710

https://doi.org/10.1016/S0016-5107(04)02017-6 Get rights and content

Background

Endoscopic techniques are being developed for the local treatment of early stage esophageal cancer. However, such therapy is not appropriate for patients with lymph node metastasis. The aim of this study was to analyze the histopathologic features of high-grade dysplasia and early stage adenocarcinoma and to relate these to lymph node involvement.

Methods

Pathology reports were reviewed for all 367 patients who underwent subtotal esophagectomy for high-grade dysplasia or adenocarcinoma of the esophagus or the gastroesophageal junction between January 1993 and December 2001. Patients with histopathologically confirmed high-grade dysplasia or T1 carcinoma were included (n = 77). Pre-operative EUS results were assessed. All lesions were histopathologically subdivided in 6 different stages (mucosal 1-3 and submucosal 1-3).

Results

EUS staged 61 patients as N0. EUS correctly predicted the absence of positive lymph nodes in 57 (93%) of these patients. Histopathologically, m1, m2, m3, and sm1 cancers never had lymph node metastases, whereas 3 of 13 sm2 tumors (23%) and 9 of 13 sm3 tumors (69%) had lymph node involvement. Lymphangio invasion was present exclusively in sm2 and sm3 cancers. Factors that predicted the presence of lymph node metastasis were the following: tumor diameter greater than 3 cm, infiltration of malignancy beyond sm1, poor differentiation grade, and lymphangio invasion, although only infiltration beyond sm1 remained significant in the definitive multivariate analysis.

Conclusions

EUS and the histopathologic features of high-grade dysplasia and early stage adenocarcinoma of the esophagus or the gastroesophageal junction can predict the presence of lymph node involvement. These data can be used to identify patients for whom local endoscopic treatment may be appropriate.

Section snippets

Patients and methods

Data for all patients who underwent surgery for carcinoma of the esophagus or the GEJ in a single, large, tertiary referral center were obtained from a database. Between January 1993 and December 2001, 367 patients underwent subtotal esophageal resection with proximal gastrectomy for pre-operatively diagnosed HGD or adenocarcinoma. No patient received neoadjuvant chemotherapy or radiotherapy. All patients with histopathologically proven HGD (n = 13) or pT1 invasive adenocarcinoma (n = 64) were

Results

Of 367 patients who underwent surgery, 77 (21%) patients (69 men, 8 women; median age 67 years, range 48-83 years) had HGD or an early stage adenocarcinoma.

Discussion

The present study is an attempt to describe the histopathology of early stage esophageal and gastroesophageal neoplastic lesions and their relationship to lymph node metastases to identify those that are suitable for endoscopic treatment. It was found that mucosal lesions (m1 and m2), tumors infiltrating the muscularis mucosae (m3), and tumors with minimal submucosal involvement (sm1) never had associated lymph node metastases or lymphangio invasion. In contrast, for 23% of sm2 and 69% of sm3

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Original ArticlePrediction of appropriateness of local endoscopic treatment for high-grade dysplasia and early adenocarcinoma by EUS and histopathologic features

Background

Methods

Results

Conclusions

Section snippets

Patients and methods

Results

Discussion

Gastrointest Endosc

Am J Gastroenterol

Ann Thorac Surg

Gastroenterology

Gastroenterology

Am J Gastroenterol

Gastrointest Endosc Clin N Am

Gastrointest Endosc

J Thorac Cardiovasc Surg

Am J Surg

Gastrointest Endosc

Gastrointest Endosc

Am J Gastroenterol

Am J Gastroenterol

Gastrointest Endosc

Gastroenterology

Rising incidence of adenocarcinoma of the esophagus and gastric cardia

JAMA

Impact of endoscopic biopsy surveillance of Barrett's oesophagus on pathological stage and clinical outcome of Barrett's carcinoma

Gut

Hospital volume and hospital mortality for esophagectomy

Cancer

Oesophageal resection for high-grade dysplasia in Barrett's oesophagus

Br J Surg

Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus

N Engl J Med

Original Article
Prediction of appropriateness of local endoscopic treatment for high-grade dysplasia and early adenocarcinoma by EUS and histopathologic features